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Alignment PPO Plan Information for In-Network and Out-of-Network Providers

Medicare Advantage PPO plans allow members to receive services from in-network providers and from out-of-network providers that participate in Medicare and agree to accept the plan. Like commercial PPO plans, providers do not have to be contracted with the Alignment Health Plan Medicare Advantage PPO plans to see Alignment PPO members.

Out-of-Network (OON) providers will receive payment from Alignment Health Plan if the services are Medicare covered benefits and are medically necessary.

Alignment pays in-network providers at the contracted rate and out-of-network providers according to the most current Medicare Fee Schedule (less member co-payments or co-insurances which vary by plan).

Checking Eligibility

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  • Out-of-Network Providers (OON)
    A

    TO CHECK ELIGIBILITY YOU WILL NEED:

    • Member's Alignment ID number or Medicare ID or Medicare Beneficiary Identifier (MBI) number

    To verify member eligibility using our Interactive Voice Response (IVR) system call 1-888-517-2247 24 hours a day, 7 days a week:

    1. Select option 2
    2. Ignore the instructions to visit our website as you will not have access as an out-of-network provider
    3. Speaking responses directly to the Interactive Voice Response (IVR) will quickly lead to the eligibility information
    4. When promoted, say "Member-specific plan"
    5. The IVR will ask for a NPI number which will not be valid for an out-of-network provider
    6. Say "I don't have one"
    7. The IVR will ask for the member's Alignment ID number or Medicare ID number (MBI number)
    8. State the member's Alignment ID number or Medicare ID number (MBI number)
    9. The IVR will ask you to state the service year for benefits. (Example 2022)
    10. The IVR will respond regarding the member's eligibility

    Another option is to speak with a Provider Relations Representative about our PPO plans, plan benefits or member eligibility. Please call 1-866-646-2247 and select option 5. Provider Relations Representatives are available Monday – Friday from 5:00 am to 5:00 pm PST.

  • In-Network Providers
    A

    To access member eligibility and benefit information on Alignment Health Plan's website, go to AlignmentHealthPlan.com/providers and find "Member Eligibility" under the Provider Tools section on the left side menu.

    CREATING A NEW ACCOUNT:

    1. Go to: alignmenthealthplan.com/providers
    2. On the left side menu, select PROVIDER TOOLS (LOG-IN REQUIRED) which will take you to another page
    3. Below the login form, select CREATE AN ACCOUNT
    4. Follow the on-screen instructions

    NEEDED INFORMATION:

    1. Physician first and last name
    2. Physician individual NPI (not Group NPI)
    3. Tax ID number
    4. Physician License Number
    5. Requester contact information (first and last name, title/role, phone)
    6. Valid email address

    ALREADY HAVE AN ACCOUNT:

    1. Select the "Provider Portal Login" blue button in the middle of the Provider page
    2. Enter your login and password
    3. Forgot your login or password? 3 solutions:

    To verify member eligibility using our Interactive Voice Response (IVR) system call 1-888-517-2247 24 hours a day, 7 days a week

    1. Select option 2
    2. Speaking responses directly to the Interactive Voice Response (IVR) will quickly lead to the eligibility information
    3. When promoted, say "Member-specific plan"
    4. The IVR will ask for a NPI number
    5. State the Physician individual NPI (not Group NPI)
    6. The IVR will ask for the member's Alignment ID number or Medicare ID number (MBI number)
    7. State the member's Alignment ID number or Medicare ID Number (MBI number)
    8. The IVR will ask you to state the service year for benefits (Example 2022)
    9. The IVR will respond regarding the member's eligibility

    Another option is to speak with a Provider Relations Representative about our PPO plans, plan benefits or member eligibility. Please call 1-866-646-2247 and select option 5. Provider Relations Representatives are available Monday – Friday from 5:00 am to 5:00 pm PST.

  • All Providers
    A

    Claims Address and other Valuable Information

    Alignment PPO ID Card

    Alignment Health Plan PPO ID Front

    Front

    Alignment Health Plan PPO ID Back

    Back

Page last updated on January 09, 2024 | Y0141_24290EN_M